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Catch Them Before They Fall, by London-based analyst Christopher Bollas, is a provocative book about the handling of clinical deterioration in psychoanalytic therapy. Bollas outlines an approach to his clients’ decompensation—evolved over many years of clinical practice—that involves the provision of extended, intensive psychoanalytic sessions. Aided by rich clinical material, the book affords a fascinating glimpse into his way of working with analytic clients during some of the most difficult times in their treatments, and indeed perhaps in their lives. In describing his methods, Bollas challenges conventional psychoanalytic technique, while also deeply affirming the psychoanalytic process as a means of transforming anguish into psychic growth.
The book begins with an introduction in which Bollas essentially lays out for the reader how he came to develop his response to clients’ “breakdown.” His use of this term—often without the use of an article such as “the” or “a”—indicates that he sees breakdown not simply as a cluster of symptoms or a clinical setback, but rather as a profoundly meaningful phase in a person's struggle toward recovery and development. A patient's breakdown is ushered in by the emergence of troubling symptoms, diminished functioning, and/or detachment from the affects and relationships associated with generative living. Bollas right away criticizes the standard responses to breakdown that are offered in conventional mental health care, arguing that hospitalization and medication subvert the path from breakdown to breakthrough, and instead cement a sense of brokenness within the patient's personality. Furthermore, he suggests that the popular practices of cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT) provide superficial and irresponsible distractions from crucial inner work demanded by the patient's unconscious: “people in breakdown do not need to have someone avert their gaze from the internal world to a self-help hom